International Journal of TROPICAL DISEASE & Health 18(3): 1-7, 2016, Article no.IJTDH.13138 ISSN: 2278–1005, NLM ID: 101632866

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Studies of Urinary Schistosomiasis amongst School Age Children in Ebonyi North Senatorial District of ,

S. O. Onwe 1, O. C. Ani 2*, C. A. Uhuo 2, C. S. Onwe 2 and O. O. Odikamnoro 2

1Department of Medical Microbiology/Parasitology, Federal Teaching Hospital, , Nigeria. 2Department of Applied Biology, Ebonyi State University, Abakaliki, Nigeria.

Authors’ contributions

This work was carried out in collaboration between all authors. All authors read and approved the final manuscript.

Article Information

DOI: 10.9734/IJTDH/2016/13138 Editor(s): (1) Walid El Ansari, Professor of Public Health, University of Gloucestershire, Gloucester, United Kingdom. (2) Giovanni Rezza, Epidemiology Unit, Department of Infectious Diseases, Italian National Institute of Health, Italy. (3) Tetsuji Yamada, Chair and Professor of Health Economics, Center for Children and Childhood Studies Rutgers University, the State University of New Jersey, USA. (4) Giuseppe Murdaca, Clinical Immunology Unit, Department of Internal Medicine, University of Genoa, Italy. (5) Shankar Srinivasan, Department of Health Informatics, University of Medicine and Dentistry of New Jersey, USA. Reviewers: (1) Toru Watanabe, Niigata City General Hospital, Japan. (2) Mathilda Banwat, University of Jos, Plateau State, Nigeria. Complete Peer review History: http://www.sciencedomain.org/review-history/15752

Received 5th August 2014 Accepted 5th April 2016 Original Research Article Published 11 th August 2016

ABSTRACT

The prevalence of urinary schistosomiasis among school age children in seven primary schools in Ebonyi North Senatorial district of Ebonyi State was investigated using standard parasitological technique. Out of 525 pupils examined, 119(22.7%) were found to be excreting ova of S. haematobium in their urine, which comprised 44 females (17.5%) and 75 males (27.5%). Children between the age of 15 -16 years recorded the highest prevalence of 35.9%. Chi square test showed that the differences among the age groups are not statistically significant. The distribution of the infection was significantly high in Hill Top Primary School Amoffia Ngbo, Local Government Area with the prevalence of 55.3% when compared to other locations assayed. Children whose parents were farmers recorded the highest prevalence (26.4%) when compared to those of other occupations (p<0.05). In the same vein, children that make use of quarry pit water as their main source of water supply recorded more infection than those that use ______

*Corresponding author: Email: [email protected];

Onwe et al.; IJTDH, 18(3): 1-7, 2016; Article no.IJTDH.13138

borehole and pipe-borne water. However, health awareness programmes, provision of portable water, mass chemotherapy as well as environmental measures that may reduce population density of snail intermediate host of S. haematobium will be useful in the control of urinary schistosomiasis in the study area.

Keywords: Urinary schistosomiasis; prevalence; pupils; Ebonyi State.

1. INTRODUCTION the Niger from Wawa to Pategi and Bida, Niger [7]. Schistosoma haematobium is the causative agent of urinary schistosomiasis also called In the western region, S. haematobium is Bilharziasis. It is an important digenetic universally distributed. The highest infection trematode found in Middle East, Asia, Oceania rates are found in Ibadan, Oyo, Abeokuta and and Africa. It afflicts the poor, rural villagers, Epe area. [7] has also reported the endemic foci especially school aged children, women and in Ogoja province and around of the fishermen who lack access to safe water and Eastern region [8] states that urinary infection sanitation, and where daily activities bring due to S. haematobium is endemic all over them into direct contact with infected water Nigeria but later work by [7] has narrowed the sources. endemicity in Nigeria down to Western and Northern regions. However several works by [9,5,10,11], all indicate prevalence in the The adult organisms are found in the venous Southern and Eastern parts of Nigeria. plexuses around the urinary bladder and their released eggs traverse the wall of the bladder The health complications due to schistosomiasis causing haematuria and fibrosis of the bladder. such anaemia, UTI and nephritic syndrome have The bladder becomes calcified and there is adversely affected children of school age, increased pressure on ureters and kidneys reducing their school hours and ability to learn. otherwise known as hydronephrosis. This work therefore is aimed at determining the Inflammation of the genital due to S. prevalence of urinary schistosomiasis amongst haematobium may contribute to the propagation children of school age in Ebonyi North Senatorial of HIV [1]. Schistosomiasis is not only endemic in District of Ebonyi State, Nigeria. Nigeria but is also known to be prevalent in all countries of Africa [2]. According to estimates of 2. MATERIALS AND METHODS [3], at least 200 – 300 million are infected with the disease (and another 600 million are at risk 2.1 Study Areas of infection) and endemic in 74 developing countries. Estimates suggest that 85% of all The approximate population of the State is 2.093 schistosomiasis cases are now in sub –Saharan million (Population Census, 2006). There are Africa [4]. thirteen Local Government Areas in the state which is divided into three senatorial districts: Nigeria is one of the countries known to be highly Ebonyi North, Ebonyi Central and Ebonyi South. endemic for urinary schistosomiasis with Ebonyi North is made up of four local estimated 101.28 million persons at risk and Government areas; —Abakaliki, Ohaukwu, 25.83 million infected [5]. The estimates for Ebonyi and local Government Areas. The morbidity and mortality in affected populations major inhabitants are the Ngbo and Izzi people. are high with school age children. In Nigeria, While the Izzi people occupy three Local pocket of foci of infection have been documented Government Areas of Abakaliki, Izzi and Ebonyi; in various parts of the country. In the Northern Ngbo people only occupy Ohaukwu LGA. region, S. haematobium is marked particularly by heavy infection rates. These include the territory The major economic activity of these people is extending from Katsina, Kano, Zaria and Kaduna agricultural farming like rice farming which keeps to the Western frontier, in the region of Birinin them in constant contact to water surfaces with Kebbi, Argungu and Kankiya areas [6]. In these very few people engaged in white collar jobs. area Schistosomiasis associated with haematuria The major sources of water supply to the people infection rate up to 60%-95% have been are from rivers, dams, streams, stagnant ponds, recorded. Other Northern regions include Wulgo quarry pit water, few shallow hand dug wells region of lake Chad basin, the riverine area along which are found in few rich families and

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boreholes provided by government in some 2.4 Microscopic Method areas. These ponds, streams, quarry pit water, dams and rivers harbor most of the snail This was done in line with [12] for Sedimentation intermediate hosts from where the effective stage technique for Schistosoma haematobium . Thus of the parasite called cercariae emerge ready for 10 ml of urine was poured into the centrifuge test transmission. tube. The urine samples were centrifuged at 1000 g rpm for 5 minutes. After centrifugation, The people are infected as they come in contact the supernatant fluid was decanted and the with water from contaminated ponds and streams sediment was mixed and a drop was placed on a during farming, fetching water, washing and clean, grease free slide. It was covered with a swimming. The mode of infection is by the cover glass and examined using x10 objective penetration/piercing of the skin by the cercaria and x40 objective of the microscope in search of infective stage. the S. haematobium ova.

2.2 Sampling Technique 2.5 ETHICAL CLEARANCE

A total of 525 pupils were sampled from seven Ethical approvals were obtained on the sample primary schools namely Central School Ngbo children from the Directorate of Research and (57), Hill Top Primary School Ngbo (76), Innovation Ebonyi State University Abakaliki. Amaeffia Community Primary School Ngbo (74), Informed consent were also sort from the school Igbeagu Central School Izzi (60), Junction head teachers, teachers and their parents on Primary School Nwezenyi (61), Oguzoronweya privacy of students, informing them that samples Primary School Ozibo (97) and Okaria Nkaleke collected from them will only be used for Community Primary School (100). The children’s research to assist in their diagnosis. There was ages range between 6-17 yrs and their sex were no clash of interest among authors. also noted. The teachers and pupils were enlightened on the relevance of the study especially the public health significance. The 3. RESULTS method of urine collection was also explained to them. After this the pupils were randomly The result revealed that in a total of 525 selected. The children were given serial number pupils who were examined for Schistosoma and containers were distributed noting on the haematobium infection, 119 pupils were found to container their age and sex. Collection was done be excreting ova of Schistosoma haematobium in and immediately taken to the Federal Teaching their urine. This gave a prevalence of 22.7%. Hospital laboratory for immediate examination. Among the different age groups, children of 15 - 2.3 Macroscopic Method 16 years age range recorded the highest prevalence of 35.9%, followed by those under This involves noting the appearance of the urine 9-10 years while those between 11-12 years samples. The color and appearance of each recorded the least infection rate (17.4%) urine sample was noted. Each urine sample was (Table 1). However, the differences were not poured into clean 10 ml centrifuge tube and statistically significant ( χ2 = 8.995; df=1; properly labeled. P > 0.05).

Table 1. Distribution of Schistosoma haematobium infection amongst primary school pupils in Ebonyi North in relation to age groups

Age group No of pupils examined No of pupils infected % of infection <6. 11 2 18.2% 7-8 53 12 22.6% 9-10 105 30 28.6% 11-12 172 30 17.4% 13-14 134 29 21.6% 15-16 39 14 35.9% 17 11 2 18.2% ∫Total 525 119 χ2=8.995; df=1; p>0.05

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Table 2. Distribution of Schistosoma haematobium infection amongst pupils in the seven primary schools in Ebonyi North in relation to location

Location No examined No infected % of infection Amaeffia Comm. prim. School 74 3 4.1% Central School Ngbo 57 21 36.8% Hill-Top Pri. School Amoffia 76 42 55.3% Igbeagu Central School 60 4 6.7% Junction Pri. School 61 0 0.0% Oguzoronweya Comm. Pri. School 97 33 34.0% Okaria-nkaleke Comm. Pri. School 100 16 16.0% Total 525 119 22.7% χ2=103.538; df=1; p<0.05

Table 3. Distribution of Schistosoma haematobium infection amongst pupils in Ebonyi North in relation to Sex

Sex (Gender) No examined No infected % of infection % to total infection Female 252 44 17.5% 37% Male 273 75 27.5% 63% Total 525 119 22.7 100% χ2=7.494;df=1;p<0.05

The distribution of infection among the different Table 5. Relationship between infection and schools showed that pupils of Hill Top Primary type of water source in use in the overall School Amofia Ngbo had the highest infection population study rate of 55.3%. This was followed by Central School Mgbo (36.8%), Oguzoronweya Water source Total No with % Community Primary School (34.0%) while no infection infection was recorded in Junction Primary Borehole 274 0 0% School, Ezza Mgbo (Table 2). Pond 24 13 54.2% Quarry pit water 14 13 92.9% Infection among sexes was higher in males Stream 213 93 43.7% (63%) than in females (37%) and the difference Total 525 119 22.7% was statistically significant ( χ2=7.49; df =1; χ2=186.808; df=3; p<0.05 p<0.05) (Table 3). Children that make use of quarry pit water as Children whose parents were farmers recorded their main source of water supply recorded the highest prevalence of (26.4%) when highest infection rate (92.9%), followed by those compared to those of other occupations while that use pond water (54.2%) and those that use children of traders had 9.3%. Children of artisans stream water (43.7%). On the other hand, those and civil servants recorded no infection that use borehole water recorded no infection (χ2=18.626; df=5; p<0.05) (Table 4). (χ2=186.808; df=3 p<0.05) (Table 5).

Table 4. Relationship between infection and 4. DISCUSSION occupation of parents in the overall population study Schistosoma haematobium infection was recorded in children examined in the six of the Occupation Total No infected % infected seven primary schools surveyed in Ebonyi North Artisan 3 0 0 with a prevalence of 22.7%. This finding Civil servants 23 0 0 suggested that urinary schistosomiasis may be a Farmers 424 112 26.4 public health problem in Ebonyi North senatorial Traders 75 7 9.3 zone of Ebonyi State. The study equally agreed Total 525 119 22.7 with a number of previous finding that χ2=18.626; df=5; p<0.05 Schistosoma haematobium infection was

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endemic in Nigeria where school age children prevalent of 35.9% than other age group, the were at a greater risk of infection [6,13,9]. difference among the age groups is not statistically significant ( χ2 = 8.995; df =1; From this study, 119 (22.7%) out of 525 pupils p> 0.05) and this indicates that the infection cuts were infected with Schistosoma haematobium. across all age groups and does not depend on The high prevalent rate of infection is consistent age. This is in conformity with the work of [11] with reports already made by [5,14,15]. It is but in contrast to [14] who reported high equally consistent with reported prevalence in prevalent rates among age groups of 10-11 other areas of Nigeria such as [7] in a school years and 8-13 years. survey in the western region of Nigeria who recorded a 20% prevalence rate in children It was equally revealed that there is significant under 14 years. [15] in the survey of the difference between one school location and the inhabitants of Ebonyi, Benue river valley south other in relation to infection rate ( χ2 = 103.538; eastern Nigeria showed a prevalence rate of df =1; p<0.05) with Hill Top Primary School 23.5% from randomly selected villages. [5] in a Amoffia Ngbo recording highest prevalence of survey of urinary schistosomiasis among school 55.3% closely followed by Ngbo Central School age children in Ebonyi State also recorded 235 with prevalence of 36.8% and Oguzoronweya (26.8%) infection out of the 876 pupils examined Community Primary School with 34% with Ohaukwu local government which is part of prevalence. The high infection rate in Hill Top Ebonyi North recording significantly high Primary School and others may be attributed to prevalent rate of 49.9%. the presence of several quarry pits and several streams harboring the intermediate host (snails) All these further confirmed that adequate in which these children engage in swimming and attention was not given to the control of the washing. The major occupation of the people of disease in many parts of Nigeria [13,16] and for this area which includes farming especially rice certain reasons it is not yet considered a priority equally helps to increase level of water contact in National and local health policies and that can predispose the victim to infection. This programmes. The persistent high prevalence of report is in conformity with the study carried out Schistosoma haematobium is an indication that by [5] which recorded high prevalence among much intervention is needed. school age children in this location.

In this study, it was observed that males had a Schools in Urban and peri- urban areas like higher prevalence rate of 27.5% as compared to Igbeagu and Junction Primary Schools recorded females with prevalent rate of 17.5%. The low prevalence probably because of availability difference in gender specific prevalence of of potable water and boreholes with low number infection was statistically significant ( χ2 = 7.494; of streams. Amafia Community School’s low level df =1; p< 0.05). This is in agreement with several of infection can equally be attributed to the use of studies with similar relationships. Pugh and bore holes as main source of water supply. The Gilles, (1978) in the course of the Malumfashi study equally revealed that children whose Research Project observed that males accounted parents were farmers recorded the highest for 83% of the infection. [17,18,14] in their prevalent rate when compared with other separate studies revealed that male subjects occupation ( χ2=18.626; df=5; p<0.05) .This is in were infected more than the females. Perhaps, agreement with [14] and can be attributed to the this is due to more frequent water contact by fact that this children assists their parents males who engage in swimming hobby more thereby rendering them susceptible to infection than their female counterpart and since tradition, through close contact to water source as they socio-cultural and religious customs prohibit engage in the farm work. Also, children that females especially those in menstrual cycle from make use of stream, pond and quarry pit water bathing and swimming in certain streams, the recorded more infection than those that use females have less water contact than the males borehole and pipe borne water χ2=186.808; df=3 [5,19]. However, this finding is in contrast to [11] p<0.05. which stated that there was no sharp difference between the rate of the infection between the 5. CONCLUSION males and females. This study established a high prevalent rate of The study equally revealed that even though urinary schistosomiasis infection in Ebonyi North, pupils of age group 15-16 years recorded higher particularly Ohaukwu and Ebonyi Local

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